1
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Tedrus GMDAS, Lange LA. Memory complaints, clinical aspects, and self-esteem in adult people with epilepsy. Dement Neuropsychol 2021; 15:357-360. [PMID: 34630923 PMCID: PMC8485644 DOI: 10.1590/1980-57642021dn15-030007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022] Open
Abstract
Memory complaints are common in adult people with epilepsy (PWEs). However, the associated clinical aspects are not yet fully understood. Objective This study aims to relate the occurrence of memory complaints in PWEs with clinical aspects and self-esteem. Methods To relate the data obtained from the Memory Complaint Questionnaire (MAC-Q) with clinical aspects, 71 PWEs were assessed using the Rosenberg Self-Esteem Scale (SES), the Mini Mental State Examination (MMSE), and the Brief Cognitive Battery-Edu. These data were compared with 55 individuals in a control group (CG). Results Memory complaints (MAC-Q≥25) were significantly higher in PWEs, when compared with individuals in the CG [35 (49.3%) vs. 15 (27.2%); Student's t-test; p=0.012]. Objective cognitive performance was lower in PWEs. Memory complaints were associated with a lower educational level, the presence of depression, SES, MMSE, incidental memory, and the clock-drawing test scores in PWEs. Conclusions Memory complaints were more frequent in PWEs than in individuals in the CG, and there was a relationship with cognitive deficit, educational level, depression, and low self-esteem.
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Affiliation(s)
| | - Laura Annoni Lange
- School of Medicine, Pontificia Universidade Católica de Campinas - Campinas, SP, Brazil
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2
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Narbutas J, Van Egroo M, Chylinski D, Bahri MA, Koshmanova E, Talwar P, Besson G, Muto V, Schmidt C, Luxen A, Balteau E, Phillips C, Maquet P, Salmon E, Bastin C, Vandewalle G, Collette F. Associations Between Cognitive Complaints, Memory Performance, Mood, and Amyloid-β Accumulation in Healthy Amyloid Negative Late-Midlife Individuals. J Alzheimers Dis 2021; 83:127-141. [PMID: 34275899 DOI: 10.3233/jad-210332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive complaints are gaining more attention as they may represent an early marker of increased risk for AD in individuals without objective decline at standard neuropsychological examination. OBJECTIVE Our aim was to assess whether cognitive complaints in late middle-aged individuals not seeking medical help are related to objective cognitive outcomes known as early markers for AD risk, concomitant affective state, and amyloid-β (Aβ) burden. METHODS Eighty-seven community-based cognitively normal individuals aged 50-69 years underwent neuropsychological assessment for global cognition, using Preclinical Alzheimer's Cognitive Composite 5 (PACC5) score, and a more specific episodic memory measure. Affective state was based on self-assessment questionnaires for depression and anxiety. Aβ PET burden was assessed via [18F]Flutemetamol (N = 84) and [18F]Florbetapir (N = 3) uptake. Cognitive complaints were evaluated using Cognitive Difficulties Scale. RESULTS Higher cognitive complaints were significantly associated with lower episodic memory performance and worse affective state. Moreover, higher level of cognitive complaints was related to higher (but still sub-clinical) global Aβ accumulation (at uncorrected significance level). Importantly, all three aspects remained significant when taken together in the same statistical model, indicating that they explained distinct parts of variance. CONCLUSION In healthy Aβ negative late middle-aged individuals, a higher degree of cognitive complaints is associated with lower episodic memory efficiency, more anxiety and depression, as well as, potentially, with higher Aβ burden, suggesting that complaints might signal subtle decline. Future studies should untangle how cognitive complaints in healthy aging populations are related to longitudinal changes in objective cognition and AD biomarker correlates.
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Affiliation(s)
- Justinas Narbutas
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liège, Liège, Belgium
| | - Maxime Van Egroo
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Daphne Chylinski
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Mohamed Ali Bahri
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Ekaterina Koshmanova
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Puneet Talwar
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Gabriel Besson
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Vincenzo Muto
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Christina Schmidt
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liège, Liège, Belgium
| | - André Luxen
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Evelyne Balteau
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Christophe Phillips
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Pierre Maquet
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Department of Neurology, CHU Liège, Liège, Belgium
| | - Eric Salmon
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liège, Liège, Belgium.,Department of Neurology, CHU Liège, Liège, Belgium
| | - Christine Bastin
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liège, Liège, Belgium
| | - Gilles Vandewalle
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium
| | - Fabienne Collette
- GIGA-Institute, Cyclotron Research Centre/In Vivo Imaging, University of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology and Educational Sciences, University of Liège, Liège, Belgium
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3
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Lee M, Nam JH, Yi E, Bhimla A, Nelson J, Ma GX. Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly. Brain Sci 2021; 11:1155. [PMID: 34573176 PMCID: PMC8472213 DOI: 10.3390/brainsci11091155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer's disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Jin-Hyeok Nam
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Elizabeth Yi
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Julie Nelson
- Philadelphia Senior Center, Philadelphia, PA 19147, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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4
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Borelli WV, Labrea VN, Leal-Conceicao E, Portuguez MW, Costa JCD. Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:238-247. [PMID: 33886797 DOI: 10.1590/0004-282x-anp-2020-0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is a perception that is not objectively measured in screening tests. Although many tools are available for evaluating SCD, no single gold standard is available for classifying individuals as presenting SCD, in the Portuguese-speaking population. The aim of this study was to systematically review the literature for tools used to evaluate SCD in the Portuguese-speaking population. METHODS Four databases (Web of Science, SciELO, LILACS and MEDLINE) were primarily utilized in this study (Phase 1). Subsequently, we conducted a manual search of the literature (Phase 2). We then retrieved tools for critical evaluation (Phase 3). Studies that matched the inclusion criteria were analyzed. We summarized the features of each tool in terms of the number of questions, scoring system, benefits and deficiencies, translation and validity. RESULTS A total of 30 studies utilizing four questionnaires and seven different single questions were found. The tools retrieved were the Memory Assessment Questionnaire (MAC-Q; 12/30 studies), single-question methods (7/30 studies), Subjective Memory Complaint Scale (SMC scale; 5/30 studies), Prospective and Retrospective Memory Questionnaire (PRMQ; 3/30 studies) and Memory Complaint Scale (MCS; 3/30 studies). Only two were formally translated and validated for the Portuguese speaking population (PRMQ and MCS). CONCLUSIONS In summary, SCD is still underinvestigated in Portuguese-speaking countries. The MAC-Q was the most commonly used tool in Portuguese, despite its lack of formal translation and validation for the Portuguese-speaking population. Further studies are required in order to develop and validate a screening tool that includes questions for detecting SCD-plus features and affective symptoms, so as to improve its predictive value.
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Affiliation(s)
- Wyllians Vendramini Borelli
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brazil
| | - Vanessa Nicola Labrea
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre RS, Brazil
| | | | - Mirna Wetters Portuguez
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brazil
| | - Jaderson Costa da Costa
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
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5
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Kim WH, Kim BS, Chang SM, Lee DW, Bae JN. Relationship between subjective memory complaint and executive function in a community sample of South Korean elderly. Psychogeriatrics 2020; 20:850-857. [PMID: 32808460 DOI: 10.1111/psyg.12592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to investigate the association between subjective memory complaint (SMC) and executive function in a community sample of South Korean elderly. METHOD Data for 1442 non-cognitive impaired elderly individuals aged 65 and over were selected from a nationwide dementia epidemiological study conducted in South Korea. Global cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The registration and recall subscales of the MMSE were used for evaluating memory function. Executive function was measured by using the Initiation/Perseveration (IP) subscale of the Korean dementia rating scale (K-DRS). RESULTS Of the 1442 participants, 1088 were in the normal control group and 354 were in the SMC group. In the SMC group, compared to the normal control group, the proportion of depression was significantly higher, total MMSE scores, delayed recall score and total IP scores were significantly lower, and the mean scores of complex/simple verbal IP, alternating movements, and graphomotor design were lower. In the unadjusted linear regression model, the SMC significantly associated with a lower score of total MMSE-KC, MMSE delayed recall, K-DRS IP, complex/simple verbal IP, alternating movements and graphomotor design. After adjusting for age, gender, education, marital status, alcohol consumption, smoking behaviour, and depression, the SMC were significantly associated with lower total MMSE score, MMSE delayed recall, K-DRS IP, and K-DRS complex/simple verbal IP. CONCLUSION In this population-based sample, individuals with SMC had evidence of lower performance on global cognition, memory function, and executive function, especially verbal fluency, after adjusting for demographic variables and depression.
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Affiliation(s)
- Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, South Korea
| | - Byung-Soo Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Sung-Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Dong-Woo Lee
- Department of Psychiatry, Inje University College of Medicine, Seoul, South Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, South Korea
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6
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Liu HY, Wang HP, Chen CY, Wu CC, Hua MS, Lin YE, Lin YC, Shyu YIL. Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults. Int J Geriatr Psychiatry 2020; 35:1209-1218. [PMID: 32510713 DOI: 10.1002/gps.5358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery. METHODS Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach. RESULTS Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs. CONCLUSIONS Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture.
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Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Ping Wang
- School of Nursing, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mau-Sun Hua
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Chi Lin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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7
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Yap KH, Warren N, Allotey P, Reidpath DD. Chronic disease profiles of subjective memory complaints: a latent class analysis of older people in a rural Malaysian community. Aging Ment Health 2020; 24:709-716. [PMID: 30588848 DOI: 10.1080/13607863.2018.1550632] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Subjective memory complaints (SMC) are common in the elderly and have been suggested as the first subtle sign of decline which can predict dementia. Cognitive decline is thought to be related to inflammatory processes similarly found in other chronic diseases and conditions such as stroke, heart disease and arthritis. This study aimed to examine the association of SMC with chronic diseases and the profile of these health conditions reported by a group of older adults.Methods: Data from a cross-sectional survey conducted from August 2013 and March 2014 was drawn from 6179 individuals aged 56 years and above. Multivariable logistic regression analyses were used to examine SMC's relationship with individual chronic diseases (asthma, kidney disease, heart disease, stroke, arthritis, hypertension and diabetes) and multimorbidity. Latent class analysis (LCA) was used to identify the profile of health conditions. The effect of SMC was estimated in a multinomial logistic regression as part of the latent class model.Results: SMC was statistically significant in its association with asthma, stroke, heart disease, arthritis and multimorbidity in the fully controlled multivariable logistic regression models. Three health profiles were identified: low comorbidity (n = 4136, low rates in all health conditions), arthritis group (n = 860) and diabetes and hypertension group (n = 1183). SMC was associated with arthritis group (OR = 2.04, 95% CI = 1.51-2.75) and diabetes and hypertension group (OR = 1.22, 95% CI = 1.03-1.46).Conclusion: Adapting a combination of analytical approaches allows a better understanding in the assessment of SMC's relationship with chronic diseases and the patterns of distribution of these health conditions.
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Affiliation(s)
- Kwong Hsia Yap
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Narelle Warren
- School of Social Sciences, Clayton Campus, Monash University, VIC, Australia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.,International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
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8
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Gorodeski EZ, Hashmi AZ. Integrating assessment of cognitive status in elderly cardiovascular care. Clin Cardiol 2019; 43:179-186. [PMID: 31845363 PMCID: PMC7021647 DOI: 10.1002/clc.23318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/08/2019] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular clinicians tend to pay little attention to issues related to cognition, and yet those caring for older adults will encounter a variety of conditions that may lead to cognitive impairment. Most commonly, these include cardiovascular disease-specific conditions such as cerebrovascular disease or heart failure, but may also include neurodegenerative conditions, mood disorders, medication side effects and polypharmacy, and nutritional deficiencies and metabolic derangements among others. This review presents evidence supporting the importance of assessing cognitive status in older adults with cardiovascular disease, and suggests a practical approach to assessment and management of cognitive impairment in this population when it is found. Special attention is paid to the importance of collaboration between cardiovascular and geriatric specialists, and the value it may bring to patients.
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Affiliation(s)
- Eiran Z. Gorodeski
- Department of MedicineCase Western Reserve University School of MedicineClevelandOhio
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical CenterClevelandOhio
| | - Ardeshir Z. Hashmi
- Center for Geriatric Medicine, Medicine Institute, Cleveland ClinicClevelandOhio
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9
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Tsapanou A, Vlachos GS, Cosentino S, Gu Y, Manly JJ, Brickman AM, Schupf N, Zimmerman ME, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Stern Y, Scarmeas N, Mayeux R. Sleep and subjective cognitive decline in cognitively healthy elderly: Results from two cohorts. J Sleep Res 2019; 28:e12759. [PMID: 30251362 PMCID: PMC6688963 DOI: 10.1111/jsr.12759] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 01/24/2023]
Abstract
Subjective cognitive decline may reflect a dementia prodrome or modifiable risk factor such as sleep disturbance. What is the association between sleep and subjective cognitive decline? Cross-sectional design, from two studies of older adults: the WHICAP in the USA and the HELIAD in Greece. A total of 1,576 WHICAP and 1,456 HELIAD participants, without mild cognitive impairment, dementia or severe depression/anxiety, were included. Participants were mostly women, with 12 (WHICAP) and 8 (HELIAD) mean years of education. Sleep problems were estimated using the Sleep Scale from the Medical Outcomes Study. Subjective cognitive decline was assessed using a structured complaint questionnaire that queries for subjective memory and other cognitive symptoms. Multinomial or logistic regression models were used to examine whether sleep problems were associated with complaints about general cognition, memory, naming, orientation and calculations. Age, sex, education, sleep medication, use of medications affecting cognition, co-morbidities, depression and anxiety were used as co-variates. Objective cognition was also estimated by summarizing neuropsychological performance into composite z-scores. Sleep problems were associated with two or more complaints: WHICAP: β = 1.93 (95% confidence interval: 1.59-2.34), p ≤ .0001; HELIAD: β = 1.48 (95% confidence interval: 1.20-1.83), p ≤ .0001. Sleep problems were associated with complaints in all the cognitive subcategories, except orientation for the WHICAP. The associations were noted regardless of objective cognition. At any given level of objective cognition, sleep disturbance is accompanied by subjective cognitive impairment. The replicability in two ethnically, genetically and culturally different cohorts adds validity to our results. The results have implications for the correlates, and potential aetiology of subjective cognitive decline, which should be considered in the assessment and treatment of older adults with cognitive complaints.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
- Department of Social Medicine, Psychiatry, and Neurology, 1st Neurology Clinic, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, GR
| | - Georgios S Vlachos
- Department of Social Medicine, Psychiatry, and Neurology, 1st Neurology Clinic, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, GR
| | - Stephanie Cosentino
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Yian Gu
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Jennifer J Manly
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Adam M Brickman
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Nicole Schupf
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Molly E Zimmerman
- Zimmerman Clinical Neuropsychology Lab, Department of Psychology, Fordham University, New York, NY
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Yaakov Stern
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
- Department of Social Medicine, Psychiatry, and Neurology, 1st Neurology Clinic, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, GR
| | - Richard Mayeux
- Cognitive Neuroscience Division and the Taub Institute, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York, NY
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10
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Dalpubel D, Rossi PG, de Almeida ML, Ribeiro EB, Araújo R, de Andrade LP, do Vale FDAC. Subjective memory complaint and its relationship with cognitive changes and physical vulnerability of community-dwelling older adults. Dement Neuropsychol 2019; 13:343-349. [PMID: 31555408 PMCID: PMC6753904 DOI: 10.1590/1980-57642018dn13-030012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Memory complaint (MC) is common in older adults and can be confirmed by people close to them, such as family members and caregivers. Studies show an association between MC and cognitive impairment and, hence, physical vulnerability may exacerbate MC. However, the relationship between MC and physical vulnerability is not yet clear in the literature.\. Objective to investigate the association between MC, cognitive impairment, and physical vulnerability. Methods this is a cross-sectional study. We evaluated 100 older adults with a mean age of 65 years or over. The Memory Complaint Scale (MCS), Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Vulnerable Elderly Research-13 (VES-13), Geriatric Depression Scale and a sociodemographic questionnaire were applied. Results participants were divided into two groups according to results on the MCS-A (elderly) and MCS-B (informant). Correlations were found between the MCS-A and the MMSE (p=.045/ρ=.201), ACE-R/Visual-Spatial (p=.048/ρ=.199), and ACE-R/Attention-Orientation (p=.026/ρ=.223). For the MCS-B, correlations were found with total score on the ACE-R (p=.044/ρ=-.202) and the ACE-R/Visual-Spatial (p=0.003/ρ=-.291). Conclusion MC reported by the informant indicate the need to assess, in more depth, the cognition of the older adult. Thus, for clinical practice, screening of MC through an informant is advised.
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Affiliation(s)
- Daniela Dalpubel
- Federal University of São Carlos Department of Nursing SP Brazil MSc. Department of Nursing, Federal University of São Carlos, SP, Brazil
| | - Paulo Giusti Rossi
- Federal University of São Carlos Department of Physical Therapy SP Brazil MSc. Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Mariana Luciano de Almeida
- Federal University of São Carlos Department of Nursing SP Brazil MSc. Department of Nursing, Federal University of São Carlos, SP, Brazil
| | - Estela Barbosa Ribeiro
- Federal University of São Carlos Department of Nursing SP Brazil MSc. Department of Nursing, Federal University of São Carlos, SP, Brazil
| | - Renata Araújo
- Federal University of São Carlos Department of Nursing SP Brazil MSc. Department of Nursing, Federal University of São Carlos, SP, Brazil
| | - Larissa Pires de Andrade
- Federal University of São Carlos Department of Physical Therapy SP Brazil MSc. Department of Physical Therapy, Federal University of São Carlos, SP, Brazil.,Federal University of São Carlos Department of Physical Therapy SP Brazil PhD. Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
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11
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de Almeida ML, Dalpubel D, Ribeiro EB, de Oliveira ESB, Ansai JH, Vale FAC. Subjective cognitive impairment, cognitive disorders and self-perceived health: The importance of the informant. Dement Neuropsychol 2019; 13:335-342. [PMID: 31555407 PMCID: PMC6753912 DOI: 10.1590/1980-57642018dn13-030011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is great divergence of results in the literature regarding the clinical relevance and etiology of subjective cognitive impairment (SCI). Currently, SCI is studied as a pre-clinical symptom of Alzheimer's disease, before establishing a possible diagnosis of mild cognitive impairment (MCI). The hypothesis was that SCI is associated with low cognitive performance and poor self-perceived health.
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Affiliation(s)
- Mariana Luciano de Almeida
- Universidade de São Paulo College of Nursing of Ribeirão Preto Ribeirão PretoSP Brazil MSc, College of Nursing of Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Dalpubel
- Universidade de São Paulo Medicine School of Ribeirão Preto Ribeirão PretoSP Brazil MSc, Medicine School of Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Estela Barbosa Ribeiro
- Federal University of São Carlos Nursing Department São CarlosSP Brazil MSc, Nursing Department - Federal University of São Carlos, São Carlos, SP, Brazil
| | - Eduardo Schneider Bueno de Oliveira
- Universidade de São Paulo Federal University of São Carlos Statistic Department São CarlosSP Brazil MSc, Statistic Department - Federal University of São Carlos/Universidade de São Paulo, São Carlos, SP, Brazil
| | - Juliana Hotta Ansai
- Federal University of Mato Grosso do Sul Campo GrandeMS Brazil PhD, Federal University of Mato Grosso do Sul. Campo Grande, MS, Brazil
| | - Francisco Assis Carvalho Vale
- Federal University of São Carlos Medicine Department São CarlosSP Brazil PhD, Medicine Department - Federal University of São Carlos, São Carlos, SP, Brazil
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Borda MG, Santacruz JM, Aarsland D, Camargo-Casas S, Cano-Gutierrez CA, Suárez-Monsalve S, Campos-Fajardo S, Pérez-Zepeda MU. ASSOCIATION OF DEPRESSIVE SYMPTOMS AND SUBJECTIVE MEMORY COMPLAINTS WITH THE INCIDENCE OF COGNITIVE IMPAIRMENT IN OLDER ADULTS WITH HIGH BLOOD PRESSURE. Eur Geriatr Med 2019; 10:413-420. [PMID: 31186819 PMCID: PMC6557430 DOI: 10.1007/s41999-019-00185-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/22/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE High blood pressure is a relevant risk factor for vascular damage, leading to development of depressive symptoms and dementia in older adults. Moreover, subjective memory complaints are recognized as an early marker of cognitive impairment. However, it has been established that subjective memory complaints could also be a reflection of depressive symptoms. The objective of this paper is to assess the impact of depressive symptoms and subjective memory complaints on the incidence of cognitive impairment in older adults with high blood pressure. METHODS This is a secondary analysis of the Mexican Health and Aging Study, a representative cohort composed by individuals aged ≥ 50 years. Participants with cognitive impairment in 2012 were excluded since the outcome was incident cognitive impairment in 2015. Four groups were created according to depressive symptomatology and subjective memory complaints status, analyses were stratified according to blood pressure status. The odds incident cognitive impairment was estimated through logistic regression models. RESULTS A total of 6,327 participants were included, from which 6.44% developed cognitive impairment. No differences were seen regarding the development of cognitive impairment in participants without high blood pressure. However, increased risk was evident in those with both high blood pressure and depressive symptoms (OR=2.1, 95% CI 1.09 - 4.09, p =0.026) as with high blood pressure, depressive symptoms and subjective memory complaints (OR=1.91, 9% CI 1.4 - 3.2, p= 0.001). CONCLUSION Individuals with high blood pressure have a higher risk of developing incident cognitive impairment when depressive symptoms and/or subjective memory complaints are present. Our results suggest that a sequence of events related to altered cerebral vascular dynamics is possible.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - José Manuel Santacruz
- Cognition and Memory Center, Intellectus. Hospital Universitario San Ignacio. Bogotá Colombia
- Psychiatry Department, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway
- Department of Old Age Psychiatry, King’s College. London, United Kingdom
| | - Sandy Camargo-Casas
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Carlos Alberto Cano-Gutierrez
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
- Geriatrics Unit, Internal Medicine Department, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Silvia Suárez-Monsalve
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Santiago Campos-Fajardo
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Mario Ulises Pérez-Zepeda
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia
- Geriatric Epidemiology Research Department, Instituto Nacional De Geriatría. Mexico D.F, Mexico
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Dong Y, Wang Q, Yao H, Xiao Y, Wei J, Xie P, Hu J, Chen W, Tang Y, Zhou H, Liu J. A promising structural magnetic resonance imaging assessment in patients with preclinical cognitive decline and diabetes mellitus. J Cell Physiol 2019; 234:16838-16846. [PMID: 30786010 DOI: 10.1002/jcp.28359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 01/18/2023]
Abstract
Subjective cognitive decline (SCD) is frequently reported in diabetic patients. Diabetes mellitus (DM) is associated with changes in the microstructure of the brain arise in diabetic patients, including changes in gray matter volume (GMV). However, the underlying mechanisms of changes in GMV in DM patients with cognitive impairment remain uncertain. Here, we present an overview of amyloid-β-dependent cognitive impairment in DM patients with SCD. Moreover, we review the evolving insights from studies on the GMV changes in GMV and cognitive dysfunction to which provide the mechanisms of cognitive impairment in T2DM. Ultimately, the novel structural magnetic resonance imaging (MRI) protocol was used for detecting neuroimaging biomarkers that can predict the clinical outcomes in diabetic patients with SCD. A reliable MRI protocol would be helpful to detect neurobiomarkers, and to understand the pathological mechanisms of preclinical cognitive impairment in diabetic patients.
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Affiliation(s)
- Yulan Dong
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Qi Wang
- Department of Radiology, the Hunan Province Hospital, Changsha, China
| | - Hailun Yao
- Institute of Pharmacy and Medical Technology, Hunan Polytechnic of Environment and Biology, Hengyang, Hunan, China
| | - Yawen Xiao
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Jiaohong Wei
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Peihan Xie
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Jun Hu
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Wen Chen
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Yan Tang
- Department of Ultrasound, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Hong Zhou
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China.,Hengyang Medical College, University of South China, Hengyang, China
| | - Jincai Liu
- Department of Radiology, the First Affiliated Hospital of University of South China, Hengyang, China
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14
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The predictive value of serum p-CREB level on secondary cognitive impairment in patients with mild-to-moderate craniocerebral trauma. Neurosurg Rev 2019; 42:715-720. [DOI: 10.1007/s10143-018-01072-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022]
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15
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Abstract
The purpose of this study was to examine the association between exercise and estimated cardiorespiratory fitness on subjective memory complaints in young adults. Four-hundred and 64 young adult college students (18-35 yrs) completed an online survey. Exercise behavior was assessed from the Physical Activity Vital Signs Questionnaire. Cardiorespiratory fitness was evaluated from an algorithm that included an assessment of age, gender, body mass index, waist circumference, resting heart rate, habitual physical activity behavior, and smoking status. Subjective memory complaints were assessed using the Prospective-Retrospective Memory Questionnaire. Subjective memory complaints were common among this young adult sample. However, exercise was not statistically significantly associated with prospective (β = -0.002, P = 0.25) or retrospective (β = -0.001, P = 0.26) memory complaints. Results were similar for cardiorespiratory fitness. In conclusion, we did not observe an association between exercise and estimated cardiorespiratory fitness on subjective memory complaints in young adults.
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Affiliation(s)
- Paul D Loprinzi
- a Exercise & Memory Laboratory, Department of Health, Exercise Science and Recreation Management , The University of Mississippi , Oxford , MS , USA
| | - Breanna Wade
- a Exercise & Memory Laboratory, Department of Health, Exercise Science and Recreation Management , The University of Mississippi , Oxford , MS , USA
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Associations between Prospective and Retrospective Subjective Memory Complaints and Neuropsychological Performance in Older Adults: The Finger Study. J Int Neuropsychol Soc 2018; 24:1099-1109. [PMID: 30178733 DOI: 10.1017/s135561771800053x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Subjective memory complaints (SMCs) are among the key concerns in the elderly, but their role in detecting objective cognitive problems is unclear. The aim of this study was to clarify the association between SMCs (both prospective and retrospective memory complaints) and neuropsychological test performance in older adults at risk of cognitive decline. METHODS This investigation is part of the FINGER project, a multicenter randomized controlled trial aiming at preventing cognitive decline in high-risk individuals. The cognitive assessment of participants was conducted at baseline using a modified neuropsychological test battery (NTB). SMCs were evaluated with the Prospective and Retrospective Memory Questionnaire (PRMQ) in a sub-sample of 560 participants (mean age, 69.9 years). RESULTS Having more prospective SMCs was associated with slower processing speed, but not with other NTB domains. Retrospective SMCs were linked to poorer function on NTB total score, processing speed, and memory. Executive function domain was not associated with any PRMQ ratings. Depressive symptoms and poor quality of life diluted the observed associations for NTB total score and memory. However, the association between PRMQ and processing speed remained even after full adjustments. CONCLUSIONS Our results indicate that self-reported memory problems, measured with PRMQ, are associated with objectively measured cognitive performance. Such complaints in healthy elderly people also seem to reflect reduced mental tempo, rather than memory deficits. Slowing of processing speed may thus be negatively related to memory self-efficacy. It is also important to consider affective factors among those who report memory problems. (JINS, 2018, 24, 1099-1109).
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Mackin RS, Insel PS, Truran D, Finley S, Flenniken D, Nosheny R, Ulbright A, Comacho M, Bickford D, Harel B, Maruff P, Weiner MW. Unsupervised online neuropsychological test performance for individuals with mild cognitive impairment and dementia: Results from the Brain Health Registry. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2018; 10:573-582. [PMID: 30406176 PMCID: PMC6215059 DOI: 10.1016/j.dadm.2018.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The purpose of this study is to compare online neuropsychological test performance of older adults across self-reported diagnoses of being cognitively normal, mild cognitive impairment, and dementia due to Alzheimer's disease and to determine the association of memory concerns and family history of dementia on cognitive performance. METHODS Participants completed the Cogstate Brief Battery unsupervised at home. RESULTS Data from 6463 participants over the age of 55 years were analyzed. Adults with the diagnosis of mild cognitive impairment and Alzheimer's disease were associated with poorer performance on all cognitive tests than cognitively normal adults (P < .05 for all), and online cognitive test performance significantly improved diagnostic classification (P < .001). Poorer performance on all cognitive measures was associated with memory concern (P < .001 for all) but not family history of dementia. DISCUSSION Our results provide preliminary support for the use of cognitive tests taken online without supervision as a means to improve the efficiency of participant screening and recruitment for clinical trials.
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Affiliation(s)
- R. Scott Mackin
- Department of Psychiatry, University of California, San Francisco, CA, USA
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Philip S. Insel
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Diana Truran
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Shannon Finley
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Derek Flenniken
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Rachel Nosheny
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Aaron Ulbright
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - Monica Comacho
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
| | - David Bickford
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | | | - Michael W. Weiner
- Department of Psychiatry, University of California, San Francisco, CA, USA
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco Veterans Affair Medical Center, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, CA, USA
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18
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Horn MM, Kennedy KM, Rodrigue KM. Association between subjective memory assessment and associative memory performance: Role of ad risk factors. Psychol Aging 2018; 33:109-118. [PMID: 29494182 PMCID: PMC5836750 DOI: 10.1037/pag0000217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Decline in associative memory abilities is a common cognitive complaint among older adults and is detectable in both normal aging and in prodromal Alzheimer's disease (AD). Subjective memory (SM) complaints may serve as an earlier marker of these mnemonic changes; however, previous research examining the predictive utility of SM to observed memory performance yielded inconsistent results. This inconsistency is likely due to other sources of variance that occur with memory decline such as mood/depression issues, presence of apolipoprotein E (APOE ε4) genotype, or beta-amyloid deposition. Here we examine the relationship between SM and associative memory ability in the context of factors that increase susceptibility to AD in 195 healthy adults (79 men) aged 20-94 years. Participants completed an SM questionnaire, a mood/depression scale, two associative memory tests (a word-pair and a name-face test), and were genotyped for APOE ε4. PET-amyloid imaging data were collected for a subset of those over 50 years of age (N = 74). We found that SM predicted performance on both associative memory tests even after covarying for age, sex, mood, and APOE ε4 status. Interestingly, for the name-face associative task, increased SM concerns predicted memory performance selectively in participants over the age of 60, with the APOEε4 risk group showing the strongest effect. Finally, men with higher beta-amyloid deposition reported more memory complaints. Our findings suggest that SM reliably tracks memory performance, even in cognitively healthy adults, and may reflect an increased risk for AD. (PsycINFO Database Record
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Affiliation(s)
- Marci M. Horn
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235
| | - Kristen M. Kennedy
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235
| | - Karen M. Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235
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Aiki S, Okuyama T, Sugano K, Kubota Y, Imai F, Nishioka M, Ito Y, Iida S, Komatsu H, Ishida T, Kusumoto S, Akechi T. Cognitive dysfunction among newly diagnosed older patients with hematological malignancy: frequency, clinical indicators and predictors. Jpn J Clin Oncol 2017; 48:61-67. [DOI: 10.1093/jjco/hyx159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sayo Aiki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Department of Palliative Medicine, Higashi-Osaka Hospital, Osaka
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
| | - Koji Sugano
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo
| | - Yosuke Kubota
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
| | - Fuminobu Imai
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
| | - Masahiro Nishioka
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
| | - Yoshinori Ito
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Shigeru Kusumoto
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Aichi
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Rotenberg Shpigelman S, Sternberg S, Maeir A. Beyond memory problems: multiple obstacles to health and quality of life in older people seeking help for subjective memory complaints. Disabil Rehabil 2017; 41:19-25. [DOI: 10.1080/09638288.2017.1370729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shlomit Rotenberg Shpigelman
- School of Occupational Therapy, Faculty of Medicine, Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel
- Maccabi Healthcare Services, Jerusalem and Haifa, Israel
| | | | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel
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Bernardes FR, Machado CK, Souza MC, Machado MJ, Belaunde AMA. Subjective memory complaints and their relation with verbal fluency in active older people. Codas 2017; 29:e20160109. [PMID: 28538830 DOI: 10.1590/2317-1782/20172016109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To verify subjective memory complaints and their relation to verbal fluency in older people participating in community groups. Methods An epidemiological quantitative study performed in community groups for older people in Florianópolis, state of Santa Catarina, Brazil. Data were collected by structured interview using the Memory Complaint Questionnaire (MAC-Q) and the Verbal Fluency Test (VFT) by semantic categories "animals/minute". For an inferential descriptive analysis, data with p < 5% were considered. Results Self-reported memory complaints were found in 35.7% of the sample. No association or correlation of VFT with the perception of memory obtained by MAC-Q, nor with its score was found. The VFT analysis of in individuals who reported negative perception of memory presented statistical significance. We found significant association between the perception (MAC-Q score) and presence of memory lapses (reported by the older people in question and added to the questionnaire). Conclusion We found no relation between subjective memory complaints and verbal fluency of active older people. Mnemonic complaints were correlated to the negative perception of memory and to the duration of the complaint. However, subjective memory complaints were an indicator for those individuals with negative perception of memory, being one aspect that must be considered in older people's speech when investigating a possible cognitive deterioration. Such data can assist in formulating public health care policies aimed at older people in the city, which emphasizes the importance of verifying subjective memory complaints in this population.
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Affiliation(s)
| | | | - Monique Coan Souza
- Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC), Brasil
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Burmester B, Leathem J, Merrick P. Subjective Cognitive Complaints and Objective Cognitive Function in Aging: A Systematic Review and Meta-Analysis of Recent Cross-Sectional Findings. Neuropsychol Rev 2016; 26:376-393. [DOI: 10.1007/s11065-016-9332-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 09/19/2016] [Indexed: 02/05/2023]
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Zhu J, Shi R, Chen S, Dai L, Shen T, Feng Y, Gu P, Shariff M, Nguyen T, Ye Y, Rao J, Xing G. The Relieving Effects of BrainPower Advanced, a Dietary Supplement, in Older Adults with Subjective Memory Complaints: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:7898093. [PMID: 27190539 PMCID: PMC4842387 DOI: 10.1155/2016/7898093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 01/11/2023]
Abstract
Subjective memory complaints (SMCs) are common in older adults that can often predict further cognitive impairment. No proven effective agents are available for SMCs. The effect of BrainPower Advanced, a dietary supplement consisting of herbal extracts, nutrients, and vitamins, was evaluated in 98 volunteers with SMCs, averaging 67 years of age (47-88), in a randomized, double-blind, placebo-controlled trial. Subjective hypomnesis/memory loss (SML) and attention/concentration deficits (SAD) were evaluated before and after 12-week supplementation of BrainPower Advanced capsules (n = 47) or placebo (n = 51), using a 5-point memory questionnaire (1 = no/slight, 5 = severe). Objective memory function was evaluated using 3 subtests of visual/audio memory, abstraction, and memory recall that gave a combined total score. The BrainPower Advanced group had more cases of severe SML (severity ⩾ 3) (44/47) and severe SAD (43/47) than the placebo group (39/51 and 37/51, < 0.05, < 0.05, resp.) before the treatment. BrainPower Advanced intervention, however, improved a greater proportion of the severe SML (29.5%)(13/44) (P < 0.01) and SAD (34.9%)(15/43)(P < 0.01) than placebo (5.1% (2/39) and 13.5% (5/37), resp.). Thus, 3-month BrainPower Advanced supplementation appears to be beneficial to older adults with SMCs.
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Affiliation(s)
- Jingfen Zhu
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Rong Shi
- School of Public Health, Shanghai University of TCM, Shanghai 201203, China
| | - Su Chen
- Si-Tang Community Health Service Center of Shanghai, Shanghai 200431, China
| | - Lihua Dai
- Department of Emergency Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Tian Shen
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Yi Feng
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Pingping Gu
- Southern California Kaiser Sunset, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Mina Shariff
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Tuong Nguyen
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Yeats Ye
- Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Guoqiang Xing
- Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University, Nanchong Central Hospital, Nanchong 637000, China
- Lotus Biotech.com LLC, John Hopkins University-MCC, 9601 Medical Center Drive, Rockville, MD 20850, USA
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Koyama AK, Tworoger SS, Eliassen AH, Okereke OI, Weisskopf MG, Rosner B, Yaffe K, Grodstein F. Endogenous sex hormones and cognitive function in older women. Alzheimers Dement 2016; 12:758-65. [PMID: 26806389 DOI: 10.1016/j.jalz.2015.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION We examined the association between endogenous sex hormones and both objective and subjective measures of cognitive function. METHODS We followed 3044 women up to 23 years in a prospective cohort study. We measured plasma levels of estrone, estrone sulfate, estradiol, androstenedione, testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S) in 1989-1990, conducted neuropsychologic testing in 1999-2008, and inquired about subjective cognition in 2012. RESULTS Overall, we observed little relation between plasma levels of hormones and either neuropsychologic test performance or subjective cognition. However, after adjustment for age and education, we observed a borderline significant association of higher levels of plasma estrone with higher scores for both overall cognition (P trend = .10) and verbal memory (P trend = .08). DISCUSSION There were no clear associations of endogenous hormone levels at midlife and cognition in later life, although a suggested finding of higher levels of plasma estrone associated with better cognitive function merits further research.
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Affiliation(s)
- Alain K Koyama
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Association between subjective memory complaints and depressive symptoms after adjustment for genetic and family environmental factors in a Japanese twin study. Environ Health Prev Med 2015; 21:92-9. [PMID: 26676904 DOI: 10.1007/s12199-015-0502-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between subjective memory complaints (SMCs) and depressive symptoms, with and without adjustment for genetic and family environmental factors. METHODS We conducted a cross-sectional study using twins and measured SMCs and depressive symptoms as outcomes and explanatory variables, respectively. First, we performed regression analyses using generalized estimating equations to investigate the associations between SMCs and depressive symptoms without adjustment for genetic and family environmental factors (individual-level analyses). We then performed regression analyses for within-pair differences using monozygotic (MZ) and dizygotic (DZ) twin pairs and MZ twin pairs to investigate these associations with adjustment for genetic and family environmental factors by subtracting the values of one twin from those of co-twin variables (within-pair level analyses). Therefore, differences between the associations at individual- and within-pair level analyses suggested confounding by genetic factors. RESULTS We included 556 twins aged ≥ 20 years. In the individual-level analyses, SMCs were significantly associated with depressive symptoms in both males and females [standardized coefficients: males, 0.23 (95% CI 0.08-0.38); females, 0.35 (95% CI 0.23-0.46)]. In the within-pair level analyses using MZ and same-sex DZ twin pairs, SMCs were significantly associated with depressive symptoms. In the within-pair level analyses using the MZ twin pairs, SMCs were significantly associated with depressive symptoms [standardized coefficients: males, 0.32 (95% CI 0.08-0.56); females, 0.24 (95% CI 0.13-0.42)]. CONCLUSIONS This study suggested that SMCs were significantly associated with depressive symptoms after adjustment for genetic and family environmental factors.
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König A, Crispim-Junior CF, Covella AGU, Bremond F, Derreumaux A, Bensadoun G, David R, Verhey F, Aalten P, Robert P. Ecological Assessment of Autonomy in Instrumental Activities of Daily Living in Dementia Patients by the Means of an Automatic Video Monitoring System. Front Aging Neurosci 2015; 7:98. [PMID: 26082715 PMCID: PMC4451587 DOI: 10.3389/fnagi.2015.00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/07/2015] [Indexed: 12/22/2022] Open
Abstract
Currently, the assessment of autonomy and functional ability involves clinical rating scales. However, scales are often limited in their ability to provide objective and sensitive information. By contrast, information and communication technologies may overcome these limitations by capturing more fully functional as well as cognitive disturbances associated with Alzheimer disease (AD). We investigated the quantitative assessment of autonomy in dementia patients based not only on gait analysis but also on the participant performance on instrumental activities of daily living (IADL) automatically recognized by a video event monitoring system (EMS). Three groups of participants (healthy controls, mild cognitive impairment, and AD patients) had to carry out a standardized scenario consisting of physical tasks (single and dual task) and several IADL such as preparing a pillbox or making a phone call while being recorded. After, video sensor data were processed by an EMS that automatically extracts kinematic parameters of the participants’ gait and recognizes their carried out activities. These parameters were then used for the assessment of the participants’ performance levels, here referred as autonomy. Autonomy assessment was approached as classification task using artificial intelligence methods that takes as input the parameters extracted by the EMS, here referred as behavioral profile. Activities were accurately recognized by the EMS with high precision. The most accurately recognized activities were “prepare medication” with 93% and “using phone” with 89% precision. The diagnostic group classifier obtained a precision of 73.46% when combining the analyses of physical tasks with IADL. In a further analysis, the created autonomy group classifier which obtained a precision of 83.67% when combining physical tasks and IADL. Results suggest that it is possible to quantitatively assess IADL functioning supported by an EMS and that even based on the extracted data the groups could be classified with high accuracy. This means that the use of such technologies may provide clinicians with diagnostic relevant information to improve autonomy assessment in real time decreasing observer biases.
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Affiliation(s)
- Alexandra König
- EA CoBTeK, Université Côte d'Azur (UCA) , Nice , France ; Alzheimer Center Limburg, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | | | | | - Francois Bremond
- EA CoBTeK, Université Côte d'Azur (UCA) , Nice , France ; STARS, INRIA , Sophia Antipolis , France
| | | | | | - Renaud David
- EA CoBTeK, Université Côte d'Azur (UCA) , Nice , France ; Centre Mémoire de Ressources et de Recherche, CHU de Nice , Nice , France
| | - Frans Verhey
- Alzheimer Center Limburg, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - Pauline Aalten
- Alzheimer Center Limburg, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - Philippe Robert
- EA CoBTeK, Université Côte d'Azur (UCA) , Nice , France ; Centre Mémoire de Ressources et de Recherche, CHU de Nice , Nice , France
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Ogata S, Hayashi C, Sugiura K, Hayakawa K. Association between subjective memory complaints and impaired higher-level functional capacity in people aged 60 years or older. Arch Gerontol Geriatr 2014; 60:201-5. [PMID: 25465503 DOI: 10.1016/j.archger.2014.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/24/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We aimed to investigate the association between subjective memory complaints and higher-level functional capacity in either people with long-term care needs or those who require help to maintain functional capacity. METHODS We conducted a cross-sectional study among participants aged 60 years or older. We measured subjective memory complaints, higher-level functional capacity, and depressive symptoms, and then estimated odds ratios (ORs) by multiple logistic analysis. Subjective memory complaints were used as the predictor variable, higher-level functional capacity as the outcome variable, and age, depressive symptoms, medical history of diabetes and hypertension, frequency of going out, falling within a year, and body mass index as possible confounders. We assessed higher-level functional capacity using the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence score ≤5 as a cut-off (which is associated with higher one-year mortality rates). RESULTS We conducted analyses using 501 people aged 60 years or older. Among women, subjective memory complaints were associated with impaired higher-level functional capacity after adjustment for age and depressive symptoms (OR=3.36; 95% confidence interval [CI], 1.59-7.08). Among the men, subjective memory complaints were not significantly associated with impaired higher-level functional capacity after adjustment for age and depressive symptoms (OR=1.91; 95% CI, 0.88-4.12). CONCLUSIONS Subjective memory complaints among women can indicate impaired higher-level functional capacity and may suggest higher one-year mortality rates.
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Affiliation(s)
- Soshiro Ogata
- Department of Health Promotion Science, Osaka University Graduate School of Medicine, Japan.
| | - Chisato Hayashi
- Department of Public Health Nursing, Graduated School of Nursing, Osaka City University, Japan
| | | | - Kazuo Hayakawa
- Department of Health Promotion Science, Osaka University Graduate School of Medicine, Japan
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